There are two types of dog-like monsters that roam the game that are kill-able. There are also numerous dog corpses scattered throughout different areas.
Themes of child abuse are extremely prevalent throughout the game and are visualized in cutscenes. Both physical and emotional child abuse are present and shown. The abuse mainly comes from the mother figure of the abused child. Another thing to add is that the abuse is religious in nature.
Production and use of a fictional drug is present in the game's setting. To get certain endings, a player must investigate this, but it is slightly less blatant if this side quest is avoided.
A cat is shown leaping out of a locker as a jumpscare. It meows harmlessly, but then immediately leaves the scene where grotesque squealing and squelching noises are heard. Depending on your interpretation, the cat may have been devoured/slaughtered by one of the monsters off-screen.
A text you can find suggests that one of the bosses (splithead) you must defeat is the manifestation of a dragon or "lizard" from a storybook, but the boss itself does not resemble a dragon.
Some enemies have heads resembling a bundle of tentacles or snakes, and more notably in one room there is a creature again resembling a group of tentacles or snakes.
There are somewhat large cockroach-like enemies. Although they are larger than a normal insect, they are still small and not very strong. One of the bosses is a giant larvae which returns for a second boss fight as a giant moth.
No, but the themes are present. A child is forced to carry an unwanted baby to term, but it is presumed the baby was not conceived through intercourse but rather a ritual of some kind. As such, there is underlying symbolism of child sexual abuse, even if no sex is present in the game.
One of the characters was burned alive, which is an important plot point. It comes up a lot in the second half of the game and the wounds it left are described in detail. An enemy character is killed by fire in some endings, but it is not shown in detail at all.
Avoiding spoilers with Cheryl, a child-like entity known as a Larval Stalker and another known as Grey Child are present in the game at the elementary school. Grey Children are enemies and thus kill-able, but Larval Stalkers resemble small children and are harmless and invulnerable, though sadly walk about and trip over themselves while making heartbreaking squeaking sounds.
The protagonist's wife died from an illness when their child was 3, which is mentioned briefly. Another parent dies in most endings, but they were not a good parent at all. The playable character can also die in game overs.
A child with spiritual powers is said to have caused a fire in her house, putting herself into a near-death state from the burns. It is open to interpretation how deliberate this was. The cause of the fire is retconned in a later game.
You may find the appearances and movements of some monsters to be similar to those of people with disabilities. They are shown as "unnatural" and "creepy". There is no ableist language or behaviour from the characters.